]]>VANCOUVER – Vancouver’s health authority is assuring patients their privacy is secure after firing a clerical employee who admitted to sneaking a peek at the medical records of five local media personalities.

The female staff member, who had worked for Vancouver Coastal Health for several years, accessed the files through the authority’s electronic records system on multiple occasions in October and November.

The breach was picked up in a routine audit. When confronted, the worker said she snooped out of “curiosity,” but did not share any of the information verbally or by email.

Her job was terminated on Wednesday, and the people whose files were compromised were notified. Their names and media outlets have not been identified, but a health authority spokesman said on Thursday “many Vancouverites would know who they are.”

Vancouver radio station News1130 has reported one of its “well-known media personalities” was among the group.

“We get celebrities through our hospitals on a regular basis that nobody ever hears or knows about,” said authority spokesman Clay Adams. “So we want to reassure the public that their privacy is respected and it is protected.”

By looking at the files, the woman violated a confidentiality agreement that was a signed part of the authority’s terms of employment.

Health Minister Margaret MacDiarmid said she was “horrified” by the breach.

“It’s something that should never happen. It’s completely unacceptable, and yet, it did happen.”

But MacDiarmid said she doesn’t think going back to paper files is the solution.

“But I can tell you from the auditing it is very rare. There are thousands and thousands of people who work in the province today who have access to patient records, and the only time they access those records is when they’re caring for a patient.”

President and CEO Dr. David Ostrow has apologized in a public statement to both the people impacted and also to all patients, clients and residents, saying the incident violates the trust people place in the authority.

Its privacy officer is examining whether further measures can be taken to prevent future transgressions.

“We’re clearly looking to see if there is more we need to do. But it’s hard to prevent human nature,” Adams said. “(It was) someone very clearly doing something outside of their work realm.”

B.C. Privacy Commissioner Elizabeth Denham was also notified of the breach on Wednesday, and launched an investigation.

“It is deeply troubling when an employee who has legitimate access to personal information on the job abuses that privilege,” she said in an email statement. “What is most concerning about this case is that it involves sensitive, personal health data.”

Secure and controlled access to such data is fundamental to building and maintaining trust in the health-care system, she added.

The office will work with the authority to mitigate current and future risks, Denham said.

Hundreds of employees have access to the medical files of more than one million people in the regions covered by Vancouver Coastal Health, which also includes Richmond, North and West Vancouver and parts of the Sunshine Coast and Sea-to-Sky corridor.

The improper access was discovered when the authority’s privacy office was conducting its monthly audit specifically aimed at ensuring that all employees, including doctors and nurses, only access files they are authorized to do so.

The audit randomly selects patient files who have a “do not announce” designation, and looks at who accessed the file and then examines whether it was proper. Anyone who enters a hospital can ask to have their file marked with the heightened level of privacy designation, but other staff members can also impose the label if they believe it is appropriate.

“It would draw flags if the person may have looked at a file where the person wasn’t receiving care,” Adams said.

Adams said in this particular incident two files that should not have been opened were caught. The privacy office then cross-referenced other files the worker had accessed and came up with three more breaches.

He said any time a staff member accesses a patient file in the electronic records system, a computer prompt pops up asking the worker if they are an authorized viewer. In this case, the worker would have had to select “yes” before gaining the file.

News1130 declined to give comment.

Last fall, B.C.’s privacy commissioner opened an investigation into the loss of a Vancouver Coastal Health laptop computer containing the health records of 450 patients at Toronto’s airport.

Dr. Phillip Yoon loves—nay, needs—his iPhone. Yoon, district chief of emergency medicine for Halifax’s Capital District Health Authority, refers to his phone as his “peripheral brain.” “It’s part of my body now,” he trills. “If I lost it, that would be trouble.” Yoon’s love affair should be a familiar one to his colleagues. The smartphone—and in particular, the iPhone—has left the realm of electronic plaything, and become an almost required medical tool. According to Manhattan Research, a health care consulting firm, the percentage of U.S. physicians using smartphones stands around 64 per cent and is projected to hit 81 per cent by 2012. In Canada, the trend is the same. Smartphone use in hospitals “is almost ubiquitous,” says Dr. Dante Morra of Toronto’s University Health Network.

Today, doctors with a few dollars to spare and a smidgen of electronic know-how can download applications at the iTunes store that can transform their iPhones into drug-dose calculators, fetal monitors, or remote receivers for patient records. Yoon could purchase the Anatomical Diagrams app for 3-D illustrations of the human body. He could use Medical Spanish so he can advise Spanish-speaking patients—or check Medscape to review alternatives to the lab test he wants to order.

Rural docs are especially quick to jump on the iPhone bandwagon. In India, the iPhone is being used to mount a campaign against a retinal disease that afflicts premature babies. The effort takes place mostly at remote outposts, where lab assistants use iPhones to take pictures of preemies’ eyes. They then send the pictures to pediatric eye surgeons in Bangalore for diagnosis. Some press reports refer to India’s “EyePhone.”

Closer to home, ER physicians are catching on too. Dr. Haidar Samiei, a U.K. pediatrician, sets the stage: “You’re in a dark ward in the middle of the night away from everything.” The phone rings. There’s been a trauma involving a six-year-old girl. What do you need to get done before she arrives? First, Samiei says, you guess how much she weighs. (The old standby formula is: [age in years + 4] x 2.) Then you make a list of possible drugs—approximating the correct dose for each. All this in a room brimming with stress: “And errors happen,” says Samiei. “What we get a lot with kids [is a dosage that is] 10 times off.” To reduce that error, Samiei and two colleagues designed the Paeds ED app, which allows docs to accurately predict a child’s weight, review available drugs, and calculate doses with precision—quickly (“within three or four finger swipes”).

Now a new generation of physicians is coming of age with smartphones firmly in hand. Before moving to Halifax, Yoon taught a course at the University of Alberta that “prepared medical students to make the transition from school to the hospital.” One module addressed smartphone-based medical applications. Mark Baerlocher, a fifth-year radiology resident at the University of Toronto, says that smartphone use in medical school is now the norm. And the U of A even has institutional licences for certain apps.

Baerlocher himself created Radiation Passport, an app that lists the exposure associated with various radiology exams, like CAT scans and X-rays. RP can also calculate a patient’s lifetime radiation exposure, and the associated cancer risk. Other young techies are entering the market. Last year, the University of Saskatchewan became the first Canadian school to offer a course dedicated to designing iPhone apps. Chad Jones, a former Apple employee, taught the class. He boasts that two of his students worked with a local doctor to create an app that is now being courted “by major medical companies.”

What paved the way for all of this was the reformatting of a huge medical database into a downloadable app known as Epocrates RX. Dr. Geoffrey Rutledge, chief medical officer for Epocrates Inc., says Apple approached his company to discuss the development of such a guide before the iPhone was even launched. Today, Rutledge claims Epocrates RX is used by one in three U.S. doctors. “The core of the application is a drug reference,” he explains. It also helps docs navigate a growing and complex web of prescription drugs, with a feature that can spot “interaction problems” between a patient’s multiple meds.

Still, there are concerns about iPhone use. One worry is over doctors using personal phones to view or store patient records—which raises questions about patient privacy, the integrity of medical files, and so on. There are also questions about specific apps; iTunes has no medical standards—individual doctors decide what to download. In response, some hospitals have guidelines on smartphone use. John Gillis, media relations adviser for Halifax’s Capital District Health Authority, says his doctors are forbidden from using any apps that require “patient-specific information.” Others do not. A spokesperson from Toronto’s Sunnybrook hospital noted: “Our director of IT let me know that he is not aware of any doctors at Sunnybrook that are using iPhones in their practices.” But Maclean’s spoke to one resident who says he’s used Apple apps while on rotation there.

Yet most doctors are confident having more access to information is good for patient care. “Medical practice has changed,” Yoon proclaims. It’s no longer about the physician and the patient; it’s “the physician, the patient, and an information technology device.”